HHS Proposes Standards for Minimum Essential Coverage

Under
the ACA, nonexempt individuals are required to maintain minimum essential
coverage or make a shared responsibility payment. This provision is known as
the individual mandate. The ACA
specifies the categories of individuals who are eligible to receive exemptions
from the shared responsibility payment under section 5000A of the Internal
Revenue Code, which provides nonexempt individuals with a choice: maintain
minimum essential coverage for themselves and any nonexempt family members or
include an additional payment with their federal income tax return.

This
proposed rule sets forth standards and processes under which the health
insurance exchanges will conduct eligibility determinations for and grant
certificates of exemption from the shared responsibility payment.

The
proposal also provides standards for determining whether certain other types of
health insurance coverage constitute minimum essential coverage and procedures
for sponsors to follow for a plan to be identified as minimum essential
coverage under section 5000A.

Additionally,
it proposes to designate certain types of existing health coverage as minimum
essential coverage. Sponsors of a health plan that seek to have such coverage
recognized as minimum essential coverage would have to submit information,
including the essential health benefits
covered, to the Department of Health and Human Services (HHS). Among the
essential health benefits required in the ACA are rehabilitation and
habilitation services and devices.

This
proposed rule, which complements a proposed rule issued the same day by the
Internal Revenue Service, is published in today's Federal Register.

Comments
on the rule are due March 18. APTA will analyze the proposed rule to determine
if it is necessary for the association to submit comments.

Comments

I would like to see APTA work with AMA and HHS/CMS to create a code/benefit of one preventive screening per year that would include cardiovascular, musculoskeletal and biometric data to be provided by PTs. Direct Access can provide a place at the table for us as these changes roll out.

Posted by Chip OMalley
on 2/1/2013 1:06 PM

Doesn't the association consider health, wellness, and chronic disease management of interest to us as well as rehab and habilitation?